milk supply so uneven throughout the day

My daughter is 3 months old exactly, weighs 13 lbs 3 oz. She has 2-3 poop diapers per day and seems to pee plenty. Her weight gain was good at her 2 month checkup--she was in the 90th percentile at birth and had fallen to the 75th at 2 months but her Dr. was fine with that. In the last month she gained just under a pound, so she's lost several more percentile points, which I think is still probably OK but I'm a little concerned about the trend and I don't want her weight gain to decelerate any more.

I went back to work a couple of weeks ago, but even in the week or two before that, I was really starting to notice that my milk supply is dramatically higher in the morning and wanes over the course of the day. I'm mostly going by the swallowing I hear baby doing when she nurses and how full my breasts feel. In the morning, my breasts always feel full and baby takes huge gulping swallows. In the evening she never seems satisfied despite feeding almost constantly, my breasts feel deflated and when she does seem to be getting milk, it's an occasional swallow after a lot of sucking.

I pump at work in the morning and afternoon and see baby at lunch to nurse. I leave the milk I pump generally for the next day. I have a freezer stash but I've never dipped into it (I make a deposit on Friday and a withdrawl on Monday in order to rotate it but I run at a surplus.) During the week, I always pump a few oz more than baby takes. On the weekends, I will sometimes pump in the morning because my breasts feel very full even after she has nursed once or twice. The result is that I always have a few oz of extra milk in the fridge that come from my very ample morning milk supply. She is taking 2-3 bottles during the work day, usually about 3.5 oz each (depending on how well she nurses at lunch). I will pump 6-8 oz in the morning and maybe 3-4 oz in the afternoon.

In the evenings though, she always seems hungry. I have resorted to giving her 2 oz of pumped milk a couple of times, which she gulps down. Is this a slippery slope? I know that a bottle of formula at times like this can be counterproductive but what about milk I pumped earlier that day? I worry because we're already giving bottles during the day, and I know that going back to work and pumping can sometimes result in a drop in supply. So I don't want to amplify the problem by giving bottles in the evening. Also, I would obviously rather nurse in the evenings.

Should we avoid giving her pumped milk in the evenings? What can I do to increase my supply in the evenings? If I just keep nursing her constantly in the evenings, will my supply eventually respond? Should my husband (who is with her during the day) try to offer her the bottle more often so that she isn't as hungry in the evenings?

Re: milk supply so uneven throughout the day

It is common for mothers to experience lulls in their milk supply throughout the day.
it is better for your milk supply to nurse during the lull in your supply because your baby gains a developmental benefit
from nursing with gusto when she has to work for it.

Re: milk supply so uneven throughout the day

Thanks. I guess my fear is that for whatever reason, her preference is to load up with milk in the evenings (maybe because she is not crazy about the bottle) and she thinks it will be there waiting for her, but it's not. The milk she passed up in the morning is in the fridge where it's unavailable to her and she's going hungry at night. It just makes me crazy to be putting extra milk in the freezer and meanwhile she doesn't seem to be getting what she needs.

Re: milk supply so uneven throughout the day

lots of people have lower supply in the evenings, corresponding with baby's cluster feeds (who knows which is the cause!).

what makes you think she's not getting what she needs in the evenings?

it is also normal for supply to regulate around 3-4 months, and since you are always running a surplus, that means you're having a little bit of oversupply. for some moms this is sustainable, but others will see a decrease in pump output. so just for that reason, i wouldn't "resort" to a bottle in the evening. in fact, any situation that feels like you're "resorting" to a bottle seems to be a red flag to me. just nurse nurse nurse in the evenings, keep switching her back and forth.

Re: milk supply so uneven throughout the day

I can relate to what you describe! The thing for me was to get myself out of the mindset of "using up" milk and having complete faith in the demand/supply system. If you start feeding bottles of ebm when you could be nursing, you will produce less, guaranteed. So that is obviously the opposite of what we want to happen.
To put it bluntly, I pretty much let my LO suckle on my "deflated sacks" as long as she wants because that is sending my body exactly the right message - "more milk please!" Have faith that your body will respond.
Sometimes more milk is coming out than you think. This morning my breasts did not seem very full because baby nursed quite a bit in the morning before work. I still tried to pump before leaving and pumped a whole 6 ounces out of my "empty" breasts.

Regarding weight gain, I am not saying you have nothing to worry about because I don't really know your situation, but I can tell you my experience. ALL of my babies started out in the very high percentiles of chunkiness and went slowly down in percentiles ever since until more or less stabilizing sometime in the toddler years. This is an especially common theme in breastfed babies that the standard pediatrician charts do not account for. My take? As long as they were not actually (1) losing ounces (2) literally dropping off the charts in percentile (below 5%), or (3) not regularly filling their diapers one way or another, I would not worry about it for a minute. If your pedi expresses concern, I would be careful to fully discuss it and possibly get your hands on some growth charts for breastfed babies. You can also tell a lot simply by observing whether your child seems well and is developing normally otherwise. That is the key.

For example, at my DD3's 2 month appt. she was 98th + for length and 90th for weight and I would not be at all surprised if that percentile for weight number drops significantly in the next 10 months, especially when she starts moving around more!

The truth is a lot of ff babies are overfed, which is a thought to be the reason why kids who were ff tend to have higher rates of overweight and obesity as they grow up. Sadly, we have a childhood obesity epidemic right now.

I really HTH and saves you some worry. You are doing great - keep having faith in your body! It can be hard sometimes.

Re: milk supply so uneven throughout the day

A mom either has overall normal milk production, over production, or low production. A mom cannot make enough milk some of the day and not enough other times of the same day.

In the evenings though, she always seems hungry. I have resorted to giving her 2 oz of pumped milk a couple of times, which she gulps down. Is this a slippery slope?

Yes. milk production varies throughout the day, this is normal and by Nature's brilliant design. As long as your baby has overall appropriate weight gain, is healthy, and still shows enthusiasm for nursing in general, there is nothing to worry about. The biggest potential risk to your milk supply is the fact you are back at work and have to pump part of the day, and this risk is compounded if you also give bottles when with baby instead of nursing (or scedule feedings when with baby, or 'sleep train.') A fussy period with lots of cluster feeding in the evening is very typical for babies, and also, many babies ramp up evening and nightime nursing sessions after mom's return to work, this helps overall milk production.

If you continue to be concerned about weight gain, what about taking a 'nursing vacation' on your next day off, and/or gently encouraging more nursing/longer sessions at other times of day.

Re: milk supply so uneven throughout the day

She might be looking for a way to reconnect. Instead of grabbing a bottle, what if you kept switching back and forth, back and forth, and built your supply in the evenings? Many babies, even babes of SAHMs, have cluster feedings in the evenings. They do this to increase supply.

Re: milk supply so uneven throughout the day

Thank you all so much for your helpful replies. Part of my confusion is that I know that I know that appropriate weight gain is the best indication that she's getting enough to eat but I don't know if her weight gain is appropriate. She is going to come up SEVERAL pounds short of doubling her birth weight by 5 or 6 months and she's dropping percentile points pretty quickly (by the week, not by the month or year). But she's still in a high percentile and she's gaining "enough", i.e. at the very lower limit of the appropriate range of rates (around 1/2 oz per day over the last month). My major concern is that she's already slowed down considerably in her weight gain and since I'm just now going back to work, I would hate for any impact of a decrease in supply as a consequence of that to put her below the "appropriate" weight gain rate and find out at her next well baby visit that she needs supplementation. Part of my craziness over that is probably the residual effect of having had a really rough start to breastfeeding because she was in the NICU. We worked so hard her first month to get back to exclusive breastfeeding and it was just such an emotional rollercoaster. I just want to be proactive so we don't find ourselves being told to supplement and then having to go through the whole effort of maintaining my supply while supplementing, then weaning off the supplement, etc. No fun. But I think for now I need to let go of that. We'll see what her pediatrician says at her next appointment, but for now I know she's gaining and that's probably all I need to know until we see the ped.

I did call her pediatrician's office yesterday as well as the office of our lactation consultant (I didn't speak to either her ped or our LC, I spoke to a nurse in the office and the LC on call) and they both agreed that she seems to be doing fine in terms of her weight and diapers, but then when I told them that I feel like I make plenty of milk in the morning and she is hungry and not getting what she wants in the evenings, they both basically said, "oh, problem solved then, just make sure you pump in the morning and feed her a bottle in the evening". Which, I agree with all of the posters here, just CAN'T be the right strategy. It goes against everything I've learned in this breastfeeding journey so far. The LC also wanted me to come in and rent a Symphony again and lug that to and from work with me. I mean, really? I would do it if I thought it would correct a supply issue that is taking a nose dive, but I make more milk than she eats, so as someone above pointed out, by definition I don't have a supply issue, right? So I'm very confused. I may try to get an appointment with our regular LC (who I love) if I'm still frustrated in a week or two. But I think for now, if neither of them is concerned about her weight and she's eating and making plenty of diapers, then I feel OK just giving her all she wants from bottles when she's with my husband and letting her nurse all she wants when I'm home and trusting that we'll find a rhythm.

I honestly don't even know what is going on, some days she really does seem super hungry and not getting anything, she seems to be really rooting around and hungry and not just looking for comfort and I have nothing to give her and we both get really frustrated. We had a long weekend where I spent the last 4 days straight in bed nursing and napping and the third evening was one of our most frustrating so far. Other times she wakes up from a long late afternoon nap, nurses for 2 minutes not very vigorously and then dozes again at the breast. And I've got plenty of milk left there for her, even though it's evening but she's just not that interested. I think the only thing I know for sure is that she usually doesn't nurse that well (by "well" I mean in a way that is satisfying to both of us) in the evenings for one reason or another. So I really don't know what is going on!! But I'm going to give it some time to balance itself out and see where we're at in a couple of weeks.